Venous disease is any abnormality in the blood vessels (veins) that is important for blood circulation and tissue oxygenation. Vascular disease can be fatal if left untreated.
The venous diseases we treat:
- Deep vein thrombosis
- Varicose veins
- Pelvic congestion
DEEP VEIN THROMBOSIS
Deep vein thrombosis (DVT) is a condition in which blood clots form spontaneously in the deep veins of the lower or upper limbs.
Most cases of DVT are fortunately not life-threatening and can be treated with medication. These are usually cases involving the segment of the legs below the knee or the forearm.
However, patients with DVT extending above the knee or upper arm towards the heart may be in greater danger as the clots in the DVT can break off in pieces and travel into the heart and lungs resulting in a severe condition known as Pulmonary Embolism (PE). This condition is life-threatening as it prevents oxygen transfer to the venous blood and poses a significant risk of death.
- Swollen and tender arms/legs: In the legs, the swelling and tenderness may start in the calf and then extend towards the thigh and groin. Whereas in the arms, it can start in the forearm and spread upwards towards the heart.
- Fast heartbeat (tachycardia)
Shortness of breath either in isolation or related to the limb swelling: This is a sign that the patient needs urgent and medical attention, as they may be experiencing a pulmonary embolism.
Common causes and risk factors include:
- Long periods of immobility (e.g. long-haul flights or travel journeys)
- After major surgery involving the limbs, pelvis or abdomen,
- Major trauma to the arms/legs
- Having a genetic predisposition to blood clotting, causing DVT
- Abnormal blood vessel anatomy (e.g. May-Thurner syndrome or Paget-Schroetter Syndrome)
- The presence of underlying cancer which can result in the blood being more prone to clotting (paraneoplastic syndrome)
Diagnosis is based on a high level of suspicion, including a risk factor history and ultrasound scans showing the presence of clots in the deep veins. Other associated investigations include a CT scan of the pulmonary arteries and a ventilation-perfusion scan if there is a suspicion of PE.
Other investigations include a blood screen for pro-clotting factors and tumour markers if there is underlying suspicion of cancer.
Pharmacological treatments for DVT: Depending on health history, doctors will prescribe thinning blood medication (anti-coagulation) that prevents blood clot formation and dissolves existing blood clots for about six months.
Minimally invasive mechanical treatments for DVT: If the DVT is extensive (e.g. extending up the thigh and into the pelvic veins), it is sometimes necessary to use a combination of mechanical devices and particular drugs to dissolve the clots. This process, known as thrombolysis, is usually done if the DVT is less than two weeks old and can be done as a minimally invasive procedure. The thrombolysis is a preventive measure for other long-term DVT complications including Post-Thrombotic Syndrome (PTS) and limb venous ulcers. Other additional treatments include the use of stents to keep the compressed veins open.
Varicose veins are swollen, twisted veins that are visible and just under the skin. They usually occur in the legs, but can also form in other parts of the body. Your veins have one-way valves that help keep blood flowing toward your heart. If the valves are weak or damaged, blood can back up and pool in your veins. This causes the veins to swell, which can lead to varicose veins.
- Swollen enlarged veins under the skin seen most commonly over the calf and thigh regions.
- Spider veins, a mild form of varicose veins that look like a fine network of red or blue lines just under the skin.
- Leg swelling around the ankle region, worse after prolonged periods of standing.
- Uncomfortable aching pain sensation in the legs
- In more severe cases, the skin around the ankle and inner calf region can become darkened or pigmented, itchy and scaly and develop recurrent skin infections.
- If left untreated, there can be a breakdown of skin, resulting in ulcers on the skin surface. These ulcers can sometimes rupture, causing profuse bleeding.
- May result in severe circulatory and skin problems in your legs.
- Age. The risk of varicose veins increases with age. Ageing causes wear and tear on the valves in your veins resulting in blood backflow, where it collects, instead of flowing back to your heart.
- Sex. Women are more likely to develop the condition. Hormonal changes during pregnancy, pre-menstruation or menopause may be a factor because female hormones tend to relax vein walls.
- Pregnancy. During pregnancy, hormonal changes occur, and the volume of blood in your body increases. These changes support the growing fetus, but also can produce enlarged veins in your legs.
- Positive Family history. If other family members (parents and siblings) have varicose veins, there’s a higher chance you will too.
- Obesity. Being overweight puts added pressure on your veins.
Standing or sitting for long periods. Your blood doesn’t flow as well if you’re in the same position for long periods.
Varicose veins are diagnosed through clinical examination and ultrasound scans. The ultrasound scan is essential as it will determine the cause, degree and extent of the varicose veins.
Conservative non-surgical treatment
- Includes the use of tight compression stockings. The stockings aid the flow of blood in the veins to alleviate symptoms and prevent the disease from progressing.
Minimally invasive endovenous procedures
- Only requires a small puncture in the leg.
- Probes are inserted into the vein to shrink and close it off using either heat or mechanical/ chemical means.
- Can be done under local anaesthesia and light sedation, usually as a day surgery case with same-day discharge.
- Patients can sometimes return to their normal daily activities within 1-2 days.
- Treatment techniques include:
- Radio-Frequency Ablation (RFA): This technique uses radiofrequency energy to heat up and damage the vein wall.
- Venaseal™/Venablock Glue Closure: It utilises a small amount of a special-formulated medical adhesive to seal the diseased varicose vein permenantly, rerouting blood to nearby healthy veins.
- Clarivein™ Mechanochemical Ablation: ClariVein™ combines two approaches – mechanical destruction via a thin pin-sized catheter (tube) of the vein and the injection of sclerosant to the targeted treatment area.
- Cryo-Laser and Cryo-Sclerotherapy (CLaCs): This procedure causes a selective photo-thermolysis of the varicose vein wall via combining transdermal laser effect and injection sclerotherapy using a chemical sclerosant, all under skin cooling (-20°C). It is most suitable method to treat small superficial skin spider thread veins.
PELVIC CONGESTION SYNDROME
Pelvic Congestion Syndrome is a chronic condition that affects women and is caused by varicose veins in the lower abdomen or pelvis. Valves in the veins become weakened and do not close properly. As a result, blood begins to flow backwards and pools in the pelvic veins and also the connecting veins to the legs.
- An aching pain with heaviness in the pelvis that may extend to the lower back.
- Pain during intercourse
- Heavy menstrual bleeding
- Heaviness and swelling in their legs, especially on standing for long periods.
This condition typically affects 20-50 years old women who have had previous pregnancies.
- CT scan of the abdomen and pelvis
- Pelvic venogram – a procedure that is performed by inserting a catheter through the groin vein and injecting a contrast agent (a type of dye) into the veins of the pelvic organs.
Ovarian Vein Embolisation
- Involves inserting a thin catheter into the femoral vein in your groin. The catheter is guided to the affected vein with the assistance of fluoroscopy, a type of x-ray technology. Tiny titanium coils with a sclerosing agent (also used for varicose veins) are inserted through the catheter to close off the affected vein(s).
- In most cases this is done as a day surgery procedure, allowing patients to be discharged on the same day of the procedure.